by Timothy Gieseke MD, CMD

I recently cared for a post-acute patient who was seriously ill.  While at our facility, one of the important medicines for a complication of his illness was stopped by computer order entry error, but I and the team didn’t discover it until a week later at which point that complication had objectively, but likely not seriously worsened.  I didn’t have the expertise to know the optimal management of this worsening complication.  The patient was scheduled to go home soon.  Would your team disclose the error to this patient and their partner?

by Timothy Gieseke, MD, CMD

As a senior physician who has over-seen the death of many patients, I have seen many persons struggle with making important decisions for their seriously ill loved ones. In my own situation, I have regrets about some of the decisions we made for my father during his final hospitalization in 2001. Later, as I developed more expertise helping patients with Advance Care Planning (ACP) for future emergencies, I was able to help my mother have the kind of death that she wanted.

by Flora Bessey, Pharm.D., CGP

Tell me if this scenario sounds familiar: a patient is admitted from the hospital for a short-term rehab stay. Within the long list of discharge meds is a C2 medication for pain control, and there is no triplicate from the discharging physician authorizing this medicine (as usual). Now, the facility begins to scramble to ensure that the resident’s pain is adequately managed…

First, call the attending at the facility; can we get an “emergency fill?” or can you come in to sign the paper work? This can certainly be an issue on weekends, after-hours, or holidays but many times during working hours! Note an emergency authorization given verbally to a pharmacist by the prescriber is good for 72 hours and can be filled for a maximum of a 7 day supply.

by Michael Wasserman, MD, CMD

In his 1974 Cal Tech commencement address, Dr. Richard Feynman coined the term “Cargo Cult Science.”  It was based on the experience of the indigenous people of the South Sea Islands during WWII.  “In the South Seas there is a Cargo Cult of people.  During the war they saw airplanes land with lots of good materials, and they want the same thing to happen now.  So they’ve arranged to make things like runways, to put fires along the sides of the runways, to make a wooden hut for a man to sit in, with two wooden pieces on his head like headphones and bars of bamboo sticking out like antennas—he’s the controller—and they wait for the airplanes to land.  They’re doing everything right.  The form is perfect.  It looks exactly the way it looked before.  But it doesn’t work.  No airplanes land.  So I call these things Cargo Cult Science, because they follow all the apparent precepts and forms of scientific investigation, but they’re missing something essential, because the planes don’t land.”

What does this have to do with Long Term Care?  Or, CALTCM’s Annual Meeting?  A lot.